Oregon Voter Registration Card you may use this form to g g
register to vote update your information
If you are not yet 18 years of age, you will not receive a ballot until an election occurs on or after your 18th birthday.
*5E8106*
Clear Form
Save As SEL 500 rev 11/19
qualifications
Are you a citizen of the United States of America?
yes
no
Are you at least 16 years of age?
yes
no
If you mark no in response to either of these questions, do not complete this form. The deadline to register to vote is the 21st day before an election.
Print with a black or blue pen to complete the form. Sign the form.
Only registered voters are eligible to sign petitions.
Mail or drop off the form at your County Elections Office. Your County Elections Office will mail you a Voter Notification Card to confirm your registration.
personal information *required information
last name*
first*
middle
Oregon residence address, city and zip code (include apt. or space number)* date of birth (month/day/year)*
county of residence
phone
mailing address, including city, state and zip code (required if different than residence)
oregonvotes.gov 1 866 673 8683 se habla español
1 800 735 2900
for the hearing impaired
information disclosure Information submitted on an Oregon Voter Registration Card is public record. However, information submitted in the Oregon Driver's License section is, by law, held confidential.
assistance If you need assistance registering to vote or voting please contact your County Elections Official. See reverse for contact info.
You must provide your valid Oregon Driver's License, Permit or ID number. A suspended Driver's License is valid, a revoked Driver's License is not valid.
Oregon Driver's License/ID number
political party
Provide a valid Oregon Driver's License, Permit or ID:
Not a member of a party Constitution
-or-
Democratic
If you do not have valid Oregon ID, provide the last four digits of your Social Security number.
I do not have a valid Oregon Driver's License/Permit/ID. The last 4 digits of my Social Security Number (SSN) are:
-or-
x x x-x x-
If you do not have valid Oregon ID or Social Security number, provide a copy of one of the following that shows your name and current address. acceptable identification g g g g g g
valid photo identification a paycheck stub a utility bill a bank statement a government document proof of eligibility under the Uniformed and Overseas Citizens Absentee Voting Act (UOCAVA) or the Voting Accessibility for the Elderly and Handicapped Act (VAEH).
Independent Libertarian Pacific Green Progressive Republican Working Families
I do not have a valid Oregon Driver's License/Permit/ID or a SSN. I have attached a copy of acceptable identification.
Other
signature I swear or affirm that I am qualified to be an elector and I have told the truth on this registration.
sign here
date today
If you sign this card and know it to be false, you can be fined up to $125,000 and/or imprisoned for up to 5 years.
registration updates Complete this section if you are updating your information. previous registration name
previous county and state
home address on previous registration
date of birth (month/day/year)
